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Comparative Study
. 2018 Jan;87(1):17-21.
Epub 2018 Jan 31.

Hip Hemi-Arthroplasty vs Total Hip Replacement for Displaced Intra-Capsular Hip Fractures: Retrospective Age and Sex Matched Cohort Study

Daniel Dawson  1 , David Milligan  1 , Fayaz Callachand  1 , Laurence Cusick  1
Affiliations
Comparative Study

Hip Hemi-Arthroplasty vs Total Hip Replacement for Displaced Intra-Capsular Hip Fractures: Retrospective Age and Sex Matched Cohort Study

Daniel Dawson et al. Ulster Med J. 2018 Jan.

Abstract

Introduction: The Royal Victoria Hospital in Belfast is the largest volume hospital in the UK Hip Fracture Database. Management of displaced intra-capsular hip fractures is evolving in light of NICE2 and BOA guidelines3, with more patients receiving total hip replacement (THR) over hemi-arthroplasty. With current rationing within the NHS, it is vital that principles of the 'Getting It Right First time' (GIRFT) report4 are implemented and the correct treatment choice made. Our aim was to assess Barthel scores5, complication rate, blood transfusion rate and post op functional ability in two age and sex matched cohorts to see if our patient selection was appropriate.

Methods: Between January and December 2013, 2 age and sex matched cohorts each containing 46 hip fracture patients were retrospectively identified. The first group underwent Hip Hemi-Arthroplasty (HHA) and the second group underwent THR. We looked at complication rate, blood transfusion rate, pre- and post-operative locomotor ability as well as Barthel score5.

Results: Average age in the HHA group was 69.7 with an average ASA grade of 2.61, compared to 71.2 and 2.43 respectively in the THR group. Complication rate in the HHA group was 45.6% with 2/3 due to chest sepsis or urosepsis. The THR group had a complication rate of 8.7% with 3/4 due to venous thrombembolism, reflecting the better pre-morbid physiological function in this cohort. Blood transfusion rates were similar in both groups. Barthel scores5 showed average reductions of 2.67 in the HHA group and 0.30 in the THR group.

Conclusions: The application of the NICE guidelines2 for arthroplasty choice in hip fracture management has led to judicious patient selection for THR. The THR group had a significantly lower complication rate (p<0.05) and better Barthel scores5 (p<0.05) compared to the HHA group. In addition, having a higher ASA score (III or IV) or lower Barthel score5 pre-operatively were independent predictors of complication occurrence.

Keywords: GIRFT; THR; fractured neck of femur; hip fracture database; hip hemi arthroplasty.

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Conflict of interest statement

Provenance: externally peer-reviewed

Figures

Fig 1.
Fig 1.
Demonstrates the complication rate in both groups. The majority of patients (90%) in the THR group did not suffer any complications. The range of complications in the HHA group was greater. Common complications in this group were respiratory tract infection, urinary tract infection and joint infection.
Fig 2.
Fig 2.
ASA score as predictive of requiring blood transfusion
Figure 3.
Figure 3.
Complication rate according to requirement for blood transfusion
See this image and copyright information in PMC

References

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